Provider Demographics
NPI:1851797211
Name:PEDIATRIC SPEECH THERAPY ASSOCIATES
Entity Type:Organization
Organization Name:PEDIATRIC SPEECH THERAPY ASSOCIATES
Other - Org Name:SUMMIT PEDIATRIC THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEPHERD
Authorized Official - Suffix:
Authorized Official - Credentials:OTHER
Authorized Official - Phone:720-542-8737
Mailing Address - Street 1:6851 S HOLLY CIR STE 295
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80112-1019
Mailing Address - Country:US
Mailing Address - Phone:720-542-8737
Mailing Address - Fax:720-242-8085
Practice Address - Street 1:720 S COLORADO BLVD STE 150
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80246-1904
Practice Address - Country:US
Practice Address - Phone:720-542-8737
Practice Address - Fax:720-242-8085
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PEDIATRIC SPEECH THERAPY ASSOCIATES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-11-13
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2251P0200X, 225XP0200X
CO1848235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Multi-Specialty
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty